Background: Maternal chorioamnionitis usually means an otherwise healthy appearing newborn gets cultured and treated for presumptive bacterial infection pending culture results. This is often done in a NICU setting. These babies are overwhelmingly well and are discharged after they ‘rule out’. However, the need for additional treatment and care in a NICU setting as well as separation from the mother may have lasting effects. Vulnerable child syndrome (VCS) refers to the maladaptive change in parenting behavior that occurs following an apparent life threatening event occurring early in a child’s life. It is hypothesized that this event gives rise to an enduring parental perception of increased medical vulnerability in the child, leading to an increase in health care visits. We wanted to see if these ‘chorio’ babies (CB) had different resource utilization over their first 6 months of life as a possible marker for developing VCS.
Methods: The study was a retrospective review of CB babies born at an urban public teaching hospital in 2015 and IRB approved. CB were full term (FT) and had no other medical problems. Cases were matched with 2 FT infants with no medical problems born as close to the case as possible. Any baby who did not continue with our hospital for primary care through 6 mo was excluded. We collected demographics about the baby and mother. We counted the number of non-routine clinic visits (NRCV), emergency department (ED) visits, and telephone calls (TC) to our triage phone center. We compared CB and controls (Con) for total resource usage as well as usage after excluding visits that were for follow-up as advised by a physician. Two-sample t test with equal variances was used to compare the two groups and regression analysis was carried out to ascertain influence of controlling variables.
Results: There were 100 CB and 200 Con. The groups were similar, including 6m growth parameters except for statistically, though not clinically significant differences in mean birth weight (P = 0.06), gestational age (P = 0.03) and mother’s age (P <0.0001). There was a significantly higher number of TC in CB (P< 0.05), but not in ED visits or NRCV. CB had a higher probability of TC and ED. Interestingly, a positive correlation was noted between mother’s age and telephone triage calls in both groups (P<0.05).
Conclusions: The rule-out sepsis intervention at birth in term asymptomatic newborns at our institution in 2015 was associated with increase health resource utilization in the form of ED and TC in the first 6 months of life. It may be that antibiotic exposure, even for only 48 hours, can explain some of this use but not all. This evidence suggests that caregivers of CB have more concerns about their babies than Con and the rule-out sepsis evaluation may have long term effects on parenting behavior.
